For vaccine recipients:

The following questions will help us determine if there is any reason you should not get the HPV vaccine today. It does not necessarily mean you should not be vaccinated. Additional questions may be asked. If a question is not clear, please ask your healthcare provider to explain it.


GUARDIAN DETAILS (if applicable)


VACCINE RECIPIENT CHECKLIST

The following questions will help us determine if there is any reason you should not get the vaccine today



3. Have a history of allergic reaction: (This would include a severe allergic reaction [e.g., anaphylaxis] that required treatment with epinephrine or EpiPen® or that caused you to go to the hospital. It would also include an allergic reaction that caused hives, swelling, or respiratory distress, including wheezing